Different subtypes of mucin have differing properties and predominate in different disease states (MUC5AC dominates in asthma MUC5B dominates in chronic obstructive pulmonary disease (COPD) ( Ehre et al., 2019).

Disulfide bonds link these glycoproteins into large multi-multimers. Mucins (MUC5AC, MUC5B) are large adsorbent molecules binding water to form mucus and are believed to act as a scaffolding to protect and organize antimicrobial particles ( Evans et al., 2010 Zanin et al., 2016). The secretory cells (including glands, goblet cells, and Clara cells) release various particles with antimicrobial and immunomodulatory properties including lysozyme, lactoferrin, proteases, and nitric oxide, in addition to mucins ( Ganesan et al., 2013). The airway epithelium comprised of ciliated and secretory cells lines most of the conducting airways ( Widdicombe and Wine, 2015). In this review, we discuss the role of mucus clearance techniques with a proven benefit in patients with CF and NCFBE, and their potential role in patients requiring mechanical ventilation while highlighting the need for standardization and adoption of mucus clearance strategies in these patient populations.Ĭlearance of foreign particles and bacteria from the lungs is an important factor in host immunity, facilitated by the optimal functioning of the mucociliary system in conjunction with the cough reflex. Evidence for the use of adjunctive mucoactive agents and other therapies to facilitate secretion clearance in these patients are not well defined, and this subgroup still remains largely underrepresented in clinical trials. Furthermore, excessive trachea-bronchial secretions have been associated with extubation failure presenting an opportunity for intervention. This self-propagating cycle of mucus retention and airway damage leading to chronic inflammation and infections can also be applied to patients with respiratory failure requiring mechanical ventilation. A variety of airway clearance therapies both pharmacological and non-pharmacological have been shown to ameliorate disease progression in this population and have hence been assimilated into routine respiratory care. The use of airway clearance strategies as supplementary treatment in respiratory disease has been best investigated in patients with cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis (NCFBE), conditions which are traditionally characterized by excessive mucus stasis and mucociliary dysfunction. 3The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, United States.2Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.1Department of Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL, United States.Goetz 1† Kadambari Vijaykumar 2† George M.

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